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09030068 77 77 7. CITY OF CUPERTINO BUILDING DIVISION PERMIT GfiITRt<1Q�A� .4�L1 r PERMIT N0. BUILDING ADDRESS: 22218 HAMMOMD WAY FOSTER PERMIT ISSUE DATE OWNER'S NAME: 222-12- 144rMQ�� WAY $ p CONTROL NO. BUILDING PERMIT INFO ARCHTCECf/ENGINEER: BLDG ELECT PLUMB MECH p C LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing zwith Section 7000)of Division 3 of the Business and Professions Code,and my license is ADD NEW 2 0 AMP C I R TO POOL SUB-PNL;RUN UF-8 1212 3 a in full force and effect j License Class - Lre.# WIRE TH RU 3/4"SCHED 4 0 PUC CNDDUT UNDR TO BE INSTL C-0 Dale contractor .� ARCHTIECI'SDECLARAnON CONCRT& INSTLD UTLTY SHED �_<J I understand my plans shall be used as public records 4 O y Licensed Pmfcssional OWNER-BUILDER DECLARATION 2 I hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county ,$la. which requires a permit to construct altcr,improve,demolish,or repair any structure prior to ita issuance,also requires the applicant for such permit to file a signed statement $q.Ft.Floor Area Valuation —Z< that he is licensed pursuant to Uta provisions of the Contractor's License Law(Chapter 9 Xt= (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). 34258001 . 00 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(See.7044,Business Required Inspections and Professions Code:The Contractor's License Law dors not apply to an owner of property who builds or improves thereon,and who does such work himself or trough his own employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 1,as owner of the property,am exclusively contracting with licensed contractors to nstmct the project(Sec.7044.Business and Professions Code:)The Conractoes Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. B&P C fo this reason 0 I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Consent to self-insure for workees Compen- .,tn,as provided for by Section 3700 of the Labor Code,far the performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF ENEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for arc hundred dollars($100) or less) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to beco s rkers'Compensation Laws of California.Dglp Applicant f NOTICE TO APPLICANT.If,IaTtcr making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. Zn 2 CONSTRUCTION LENDING AGENCY (..h►. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name aLendees Address U 0 I certify that 1 have read this application and state that the above information is LL correct I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorizt representatives of this city to enter upon the W above-mentioned property for inspection purposes C>w (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City J / V Z in consequence of the granting of this permit. Date APPLICQUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:SOURCtSt' `i (// .�/1 ►� Re-roof: Signature of Appli zEo kctor Dare T Of Roof / HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed. DYey �]'No �T If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Act? 0 Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Cork:.Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the Date reyuire is hich must ber met 'or to issuance of a Cenificate osOc ancY•onqSign u1 a of �nn � J/ 00 All roof coverings to be Class" ``or better Date Owner or authorized agcagent ��� T ID CITY OF CUPERTINO CUPE(�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: _J Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: Y`7J Contractor: Phone: 0 Co Fax: Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential Commercial Job Description: 1 r) c+-' a © A�^r C_r C t,t;I- t S u �. �` •1 CCr t c T Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A5 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B E"—_ P `7 Val tion: Square Footage: Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.buildM.,,-een.or Revised 01/07/09 11 CITY OF CUPERTINO S" ," of GENERAL BUILDING APPLICATION CUPEI�TINO FEE S(--,'HEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Wi:idow-structural shear B wall/ma:,onry(includes plan ck fee) j 1 EPERMITFEE ElectricE I Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand A.one Electric Pln Ck (hourly) E 1MECPLNCK Stand A.one Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bld;; Standards Commission Fee B ALL PERMIT TYPES / 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B / 1TRAVDOC Travel tz Documentation B r 1BUSLIC Business License B 5 of 5 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ';UPEkTINO Building Department JOB ADDRESS: �� � PERMIT � � � c) 2-2--21k- OWNER'S NAME: os PHONE # (' v ` 2,r GENERAL CONTRACTOR: FAX # I am not using any subcontractors: /� �✓� 3 a Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date